OP0076 UPDATE OF THE EULAR RECOMMENDATIONS FOR THE NON-PHARMACOLOGICAL CORE MANAGEMENT OF HIP AND KNEE OSTEOARTHRITIS
Authors: T. Moseng, T. P. M. Vliet Vlieland, S. Battista, D. Beckwée, V. Boyadzhieva, P. G. Conaghan, D. Costa, M. Doherty, A. Finney, T. Georgiev, M. Gobbo Montoya, N. Kennedy, I. Kjeken, F. Kroon, S. Lohmander, H. Lund, C. Mallen, K. Pavelka, I. Pitsillidou, M. Rayman, A. T. Tveter, J. E. Vriezekolk, D. Wiek, G. Zanoli, N. Osteras
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The existing EULAR Recommendations for the non-pharmacological core management of hip and knee osteoarthritis (OA) were published in 2013. A considerable number of new studies on various non-pharmacological treatment modalities have been published since then. Hence, it is time to update the Recommendations for the non-pharmacological core management of hip and knee OA. <h3>Objectives</h3> The objective of this project was to perform an updated systematic literature review and to update the 2013 EULAR Recommendations for the non-pharmacological core management of hip and knee osteoarthritis, accordingly. <h3>Methods</h3> The standardised operating procedures for EULAR-endorsed Recommendations <sup>[1]</sup> were used as a framework for this project. A multi-disciplinary Task Force (TF) including 9 physiotherapists, 6 rheumatologists, 2 orthopaedic surgeons, 2 psychologists, 2 patient research partners, 1 occupational therapist, 1 nurse, 1 general practitioner and 1 nutrition expert from 13 European countries was established. Based on the original search strategy underpinning the original 11 recommendations, 11 updated PICOs (Population, Intervention, Control, Outcome) were agreed upon by the TF members in the first digital meeting in January 2022. Systematic literature searches were conducted from 1<sup>st</sup> January, 2012 until 27<sup>th</sup> May, 2022 aiming to identify new evidence related to non-pharmacological core treatment interventions for hip and knee OA. Evidence was primarily collected from published systematic reviews (SRs) and secondarily, from randomised controlled trials (RCTs) if no relevant, updated SR was available. The retrieved evidence was discussed in 5 digital subgroup meetings and subsequently presented to all TF members in the second plenary digital meeting in November 2022. Here, the recommendations were revised based on the new evidence and discussions and TF members voted on each newly proposed recommendation to reach consensus (more than 75 % in favour). After the meeting TF members completed a web-based survey to ascertain the Level of Agreement (LoA) (0-10, 10=totally agree) with each recommendation and prioritize the order of the recommendations for implementation activities. <h3>Results</h3> Based on evidence from 67 SRs and 31 RCTs, the TF agreed to rephrase and change two of the 11 existing recommendations into two overarching principles; one concerning the initial assessment with a biopsychosocial approach and one on the use of shared decision-making in treatment. The remaining 9 original recommendations were revised into 8 updated recommendations, as the recommendations on footwear and on walking aids and other assistive devices were combined. The 8 updated recommendations concern the application of: 1) an individualised, multicomponent management plan; 2) delivery of information, education and self-management strategies; 3) delivery of exercise with adequate dosage and progression; 4) the mode of delivery of exercise; 5) education on maintaining a healthy weight and support with weight loss when indicated; 6) advice on walking aids and assistive devices; 7) work-related advice; and 8) application of behaviour-change techniques to improve lifestyle. The lowest mean LOA for the 8 revised recommendations was 9.2 and the highest 9.8. Recommendation 2) was ranked by the TF as having the highest priority for implementation. <h3>Conclusion</h3> The updated overarching principles and recommendations for the non-pharmacological core management of hip and knee OA are based on previous evidence and on new evidence from relevant SRs and RCTs published during the last 10 years and on discussions by a multi-disciplinary TF. A plan for dissemination and implementation will be developed, with emphasis on the recommendation on patient education, with the ultimate aim to improve the quality of care for people with hip and knee OA. <h3>Reference</h3> [1]van der Heijde D, Aletaha D, Carmona L, et al. 2014 Update of the EULAR standardised operating procedures for EULAR-endorsed recommendations. <i>Annals of the rheumatic diseases</i>. 2015;74(1):8. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Tuva Moseng: None declared, T.P.M. Vliet Vlieland: None declared, Simone Battista: None declared, David Beckwée: None declared, Vladimira Boyadzhieva: None declared, Philip G Conaghan Speakers bureau: AbbVie, Novartis, Consultant of: AbbVie, AstraZeneca, Biosplice, BMS, Eli Lilly, Galapagos, Genascence, GSK, Merck, Novartis, Pfizer, Regeneron, Stryker, and UCB, Daniela Costa: None declared, Michael Doherty: None declared, Andrew Finney: None declared, Tsvetoslav Georgiev: None declared, Milena Gobbo Montoya Speakers bureau: STADA, Paid instructor for: Pfizer, Lilly, Consultant of: Angellini Farma; MSD, Norelee Kennedy: None declared, Ingvild Kjeken: None declared, Féline Kroon: None declared, Stefan Lohmander Consultant of: Scientific consultant Arthro Therapeutics AB, member clinical trial DSMB Astra Zeneca, Hans Lund: None declared, Christian Mallen Grant/research support from: Keele University have received funding from BMS for a nonpharmacological AF screening trial, Karel Pavelka Consultant of: AbbVie, UCB, Pfizer, Eli Lilly, Celltrion, MSD, Novartis, Grant/research support from: AbbVie, UCB, Pfizer, Eli Lilly, Celltrion, MSD, Novartis, IRENE Pitsillidou: None declared, Margaret Rayman: None declared, Anne Therese Tveter: None declared, Johanna E. Vriezekolk: None declared, Dieter Wiek: None declared, Gustavo Zanoli: None declared, Nina Osteras: None declared.